The Interview: Dr. Celine Gounder on Omicron

I figured it was a good time to get the Doc, Celine Gounder, back on my podcast to discuss Omicron and what’s happening, including its connection to the sports world. So that’s what we just did. I think there’s some useful stuff in here.

Grant Wahl:

With the Omicron variant spreading in places around the world, our guest now is my wife. Dr. Celine Gounder is an infectious disease specialist, an epidemiologist and an NYU professor who works at Bellevue Hospital. She was a member of the president's Transition COVID-19 Advisory Board, and she hosts two podcasts, Epidemic and American Diagnosis. Celine, thanks for coming back on the show.

Dr. Celine Gounder:

Good to be here.

Grant Wahl:

So we're a sports podcast, as you know, and sports are dealing with Omicron a lot, just as society is. We saw six Premier League games postponed over the weekend. The NBA and NFL are dealing with it too. We're speaking Sunday morning, December 19th. What have we learned so far about Omicron?

Dr. Celine Gounder:

So there are three main characteristics that we really focus on with the virus with the variants. One, is it more infectious? So does it spread more easily from person to person? Another way to think about that is if you are infected, how many other people are you likely to go on and infect? And there is no question Omicron is more infectious, even more infectious than Delta, which was previously the most infectious variant to date. So that makes Omicron a real concern because it is spreading rapidly through the population.

The second characteristic we worry about is immune evasion. So how well does immunity from a prior infection or immunity from vaccination protect you against infection with Omicron? We are seeing that so-called natural immunity or immunity from a prior infection is really not protective against Omicron. And the vaccines do seem to be still offering protection against infection up to a point, but we are seeing that even people who have been triple vaccinated with Pfizer and Moderna are having breakthrough infections with Omicron. I think the key message here is that those infections are very mild. They're not landing people in the hospital. They're more like the common cold. So the vaccines continue to protect very well against severe disease, hospitalization and death.

Then the third characteristic we worry about is virulence. So virulence is how severe of disease does a virus cause in the individual who's infected? And the jury's still out on that one. There was some initial data out of South Africa that indicated maybe Omicron might be less virulent, causing less severe disease, but there's also data out of the UK that suggests that's not necessarily the case. So we still really need to see more data before coming to a conclusion on that one. Part of the challenge with virulence is that we don't intentionally infect people. We can't do a randomized clinical trial infecting people and seeing is this causing more severe disease or not? You just have to wait to see how it plays out in the population, and that does take some time.

The final thing I would just say about that is that even if this Omicron variant is no more virulent than prior variants, just by the sheer fact that it is infecting so many more people, you can still end up with a lot of hospitalizations and deaths, particularly among people who are not vaccinated. So the Omicron threat really should be taken very seriously.

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Grant Wahl:

That leads to my next question, which is, we're seeing a lot of people, including here in New York City, who are vaccinated and boosted, who are getting breakthrough Omicron infections. What do you say to anyone who says this must mean the vaccine and boosters aren't working well?

Dr. Celine Gounder:

I think we've been expecting too much of the vaccines. We've been expecting perfection. It would be like saying seatbelts don't prevent all injuries in car accidents, so seatbelts are useless. The vaccines are working very well at protecting against severe disease, hospitalization and death. And after all, we vaccinate to prevent severe disease, not to prevent the common cold. So if people are having mild breakthrough infections, the sniffles, that sort of thing, maybe even what seems like a case of flu, so some chills and fever. If they're not landing in the hospital, if this is not causing lung damage and other organ damage, but really just a mild infection, that's really still a win that the vaccines are having such a tremendous impact.

Grant Wahl:

So as I understand it, you would much prefer on a population level that the administration and public health officials focused less on the number of COVID cases and more on the number of hospitalizations and deaths from COVID. Is that accurate?

Dr. Celine Gounder:

Yeah, I think we need to shift our targets. We set the goalposts at an impossible place for success. The vaccines are doing a great job protecting against severe disease, hospitalization and death. That should have been the target all along. And hey, look at New York City. So in New York City, we are heading into a COVID surge, much of this driven by Omicron, but New York City is one of the most highly vaccinated places in the country. Over 70% of New Yorkers are vaccinated. 

And to put this in perspective, what was the impact of COVID early in the pandemic in New York in spring of 2020 before we had vaccines? At Bellevue Hospital where I worked at the peak, we had over 600 COVID patients in the hospital. Today we have about 30. And that is because even though the virus is spreading across the city right now, the cases that we're seeing are pretty mild because so many New Yorkers are vaccinated. So I think it's really important to understand the people who are landing in the hospital are people who are not vaccinated by and large.

Grant Wahl:

One reason I have not wanted to get COVID, even a mild case, even as someone who's vaxxed and boosted like me, it's because I don't want to have the possibility of getting long COVID. What do we know about the impact and vaccines and boosters on the chances of getting long COVID even if you get a breakthrough infection?

Dr. Celine Gounder:

Well, there's data out of the UK, for example, looking at people who had infections who were not vaccinated and people who had so-called breakthrough infections who were vaccinated. And we do see at least a 50% reduction in odds of getting long COVID if you are vaccinated and then have an infection. But I think this goes back to what many of us public health officials have been saying, that you cannot have a vaccine-centric or overly vaccine-focused policy if your goal is to prevent all infections and to prevent long COVID. You really do have to layer other measures. And I know that's very frustrating, that people want a silver bullet of, hey, I got my vaccine, I don't have to worry about any of these things anymore. And that's unfortunately not the case right now.

So, yes, absolutely, get vaccinated. That's what will protect you against severe disease, hospitalization and death, but if what you really want to do is also minimize your risk of an infection and long COVID, the vaccines are not going to do that. We're already seeing waning immunity among people who've had a third dose. Even before Omicron, the Israelis were looking at giving fourth doses as a result. And we're going to be chasing our tails giving boosters every six months or so if we're trying to use vaccines to prevent all infections and long COVID. So at least for now we do need to be doing things like masking, I would say an N95 respirator or a KN95 or KF94 mask. You can order the right masks from projectn95.org. They have been vetting the quality of the materials. I know there's a lot of knockoffs you can get on Amazon, but that's a reliable place to order masks from.

We also need to be socializing outdoors as much as the weather allows, as much as is possible. And if you're indoors, open doors and windows, create a cross-breeze. Get yourself one of those HEPA air filtration units, put those in rooms where maybe family and friends are congregating, like living rooms, dining rooms, kitchens and the like. And then finally, make use of rapid testing. The jury is still out on how well the rapid tests are working for Omicron, but Delta is still the dominant strain at least for now in the United States, and rapid tests are performing very well for the Delta variant. Do a rapid test first thing in the morning. If you're negative, that's a day when you can more safely, I won't say perfectly safely, but more safely drop your mask when you're indoors with family and friends, especially over the holidays. And that's really how to be using those rapid tests.

Grant Wahl:

And just to be clear, these are the things that you want you and I to be doing when we travel to Kansas City on Monday and spend the next six days with our family for Christmas, correct?

Dr. Celine Gounder:

That's right. So our family, as you know, is fully vaccinated and boosted with the exception of our niece, Delphine, who's six. She just got double vaccinated. So she's not yet eligible to be boosted. And our niece, Adele, who is two years old. She is not yet eligible to be vaccinated. So everybody else is vaccinated and fully boosted. We will be wearing N95 masks while we travel, and I have already ordered a bunch of rapid tests to be sent to my sister's home so that we can rapid test every morning.

Grant Wahl:

I guess lastly here, because we are a sports podcast, the sports world has been pretty helpful actually with helping all of us learn more about the virus over the last couple years. Could you explain some of that?

Dr. Celine Gounder:

So I think the sports world really has contributed to our scientific knowledge, especially around things like testing. They're a pretty unique setting. Many of the leagues have been testing their players and staff very frequently. In some cases once a day or even multiple times a day. And they've been doing so with different types of tests, PCR tests, saliva, as well as nasal swabs, rapid tests. And so they have that wealth of data on serial testing with multiple tests at the same time where you can make cross-comparisons, you can also assess how quickly a new variant is spreading through their population. So I think the sports world has really contributed a tremendous amount to our fight against COVID over the last two years.

Grant Wahl:

I also just want to say thank you because I know that you're going back into Bellevue Hospital to work on December 27th all through the start of the new year. And you've been working seven days a week now for just about two years on all this stuff doing different things. And I just really am proud of you and appreciate it.

Dr. Celine Gounder:

Thank you. Sometimes I feel like I'm the Scrooge passing on these dire messages or depressing bits of advice, but I think if we would all just pitch in, do our part, we really could get to the other side of this.

Grant Wahl:

Thanks for coming on the show.

Dr. Celine Gounder:

Sure.